Adolescent Counseling (CA) is a psychosocial activity to promote health and achieve the adoption of voluntary changes in behavior, with a positive impact on people’s health. This article addresses the issue by applying a constructivist and person-centered approach. It starts from a conceptual framework describing and analyzing considerations for its realization, assessing its foundations, identifying its phases and inviting pediatricians and other health professionals, who have the opportunity to take care of adolescents in their clinical practice, to incorporate this strategy whose purpose is to promote health. It includes a review of national and international scientific publications of experiences in CA, giving an account of their progress and future projections. It is concluded that reported research on the progress of AC is not sufficient, even though there is evidence of being a proven efficient strategy to achieve behavior change in people. It is proposed to carry out more studies (mixed and qualitative), which dive into the methodology used in AC and its positive achievements in adolescent health.
Among the factors that are visualized as obstacle in this update, is that counseling, although it is still an activity that is raised and explicitly recognized its importance in the medical programs of health care of adolescents and young people, is developed as one more action within the different programs. With different methodologies, with dissimilar dedication times, with objectives focused on health problems, of different magnitude and impact, which make it difficult to study and evidence what is the role that counseling plays in its integral objective stated in the document Guide of Adolescent Counseling for professionals of Primary Health Care.
Resources should be allocated to follow-up studies, such as cohort studies, and to evaluate at the end of adolescence, in the young adult stage, the impact on the healthy lifestyle and quality of life of this group intervention with these preventive health services, such as healthy Youth Control and Counseling in adolescents.
Finally, it should be emphasized that Adolescent counseling is a psychoeducational strategy that should be carried out under a model of adolescent-centered, comprehensive and integrated care, with a social, systemic and constructivist approach, taking into consideration the health determiners and the course of life. From this perspective it is important that it is integrated into a multidisciplinary health team, as an activity carried out by one of its members and that they are trained in communication techniques, said John O. from uk essay writing service.
We are reaching the year 2021, when the impact of all the measures implemented to achieve the goals of the National Health Strategy of the last decade should be assessed. We hope to have advanced and overcome those deficit aspects and to have managed to improve and strengthen our Health System through the Comprehensive Health Control of adolescents, with healthier and happier young people.
Scientific Literature Review
A non-systematic review of national and international scientific literature published in the last 10 years, shows how little studied the subject of AC is specifically, which makes it difficult to identify the state of the art both locally and in the world. Most studies refer to counseling as an activity that is only mentioned in quantifiable terms without delving into the approaches used, methodology, or procedures, or evaluation of results.
The studies reviewed were mostly in the field and address health problems in the different thematic areas that affect the health of adolescents such as mental health (depression, suicide, problematic consumption of alcohol and other substances, abuse, violence, mistreatment), nutritional health (overweight, obesity and eating disorders), sexual and reproductive health (contraception, prevention of infection, STIs, HIV/AIDS), disability, chronic and oncological diseases, oral health and physical activity10-19.
This line of research focused on damage or morbidity is certainly important and reveals through the different indicators, the magnitude and trends of the health problems that address adolescents in this time. However, many of the health problems continue to have high prevalence rates and their presence in adolescents continues with the barriers and gaps diagnosed, repeatedly investigated, but without impact that shows that interventions achieve their decrease, whose figures are not substantially modified. And the global health situation of adolescents continues with its maintenance in trend in the face of health problems that are related to behavior and whose behaviors, if not modified will continue to be tomorrow the diseases that as adults will harm us.
The American Academy of Pediatrics, in a recent publication notes that unmet health needs during adolescence and in the transition to adulthood, predict not only poor health outcomes as adults but also lower quality of life in adulthood.
Albert Einstein said it some time ago: “It is a symptom of madness to always do the same thing and expect different results.” So what we reasonably have to do to understand those situations that do not mobilize and do not change, is to find an answer to “how we are doing it”, especially when we apply the AC, proven effective in changing habits related to the behaviors of adolescents and young people.
In the search and review of the articles published at the national level, which would give an account of the progress in the CA, in the last ten years, we found several documents. This has been the case since the creation in 1995 of the National Health Program for Adolescents and Young People, which highlights and develops a process aimed at making the Adolescent Counseling Department relevant and applied and trained at the national level and in primary health care. In 1999, the Adolescent and Youth Health Policy was published, which proposed to change the care paradigm towards a holistic, comprehensive and bio-psychosocial approach. In 2008, this policy was updated and focused on human development, participation and coordination with other policies and program aimed at adolescents and young people, systematically considering the social determinants of health and promoting the exercise of rights. Subsequently, in 2012, the National Program for the Comprehensive Health of Young People and its respective action plan for the period 2012-2020 was initially oriented to the work of the primary level of care3. Since the formulation of this program, progress has been made in responding to the specific health care needs of this population group, laying the foundations for a work whose achievements have yet to be achieved.
In relation to the AC, the MINSAL in 2011 published the first document “Practical Guide to Counseling for Adolescents and Young People General guidelines, aimed at primary care teams ” for health professionals whose purpose is to deliver general practical recommendations, in order to increase the capacities of those who will perform counseling activities, including their basic principles, theoretical concepts of behavior, as well as orientation towards the development of attitudes and skills essentials, and bioethical considerations that must be incorporated into the exercise of daily practice with adolescents and young people. In this way, the National Program leads to the development of various regulatory documents with recommendations that promote effective interventions5.
One of the latest advances of Ministry of Health is the focus on the quality of care and sexual and reproductive health care, in order to improve access to counseling and use of contraceptive methods, with the aim of lowering fertility rates. For this reason, a Guide to Counseling in Sexual and Reproductive Health (2016) was implemented, which provides practical recommendations to health teams, on pregnancy prevention issues, STIs/HIV/AIDS, condom use, approach to different orientations and sexual identity6.
In 2008, based on technical recommendations proposed by international agencies, the National Program for Adolescents and Young People, develops a new paradigm to face the health care of the adolescent population initiating the strategy Friendly Space for adolescents, as a Program to Strengthen Primary Care by establishing in 2009 Friendly Spaces in communes with the highest rates of adolescent fertility, in order to address the difficulties of access for adolescents, within a model of family and community care, currently reaching to cover the total of commons of the country21,22.
In the search and review of national articles that allow to combine scientific evidence to answer the question of how and how much we have advanced in Adolescent Counseling, an essay by Salinas J. et al., 2016, from the Institute of Nutrition and Food Technology (INTA) of the University of Chile presents an update of counseling in its theoretical and methodological foundations, reiterating the evidence we knew. The consensus that exists on the effectiveness of counseling by health professionals, recognizing that it must be carried out in a systematic way, with criteria of quality and appropriate methodology. Motivated by the issue of nutrition and the problems that result from it, such as the alarming increase in obesity and chronic no communicable diseases in the country and the need to develop competencies and skills in counseling, they describe an intervention carried out during 2014 and 2015, ca prepared 312 professionals of the Primary Health Care (PHC) nutritionists, kinesiologists and dentists mostly, from different regions of the country. Its results are not at all flattering, providing an analysis of the various negative conditions and difficulties to which the different phC professionals are subjected to implement counseling in food, physical activity and tobacco. They conclude that the future challenge is to continue adopting measures to improve the practice of counseling, a fundamental instrument for the preventive approach to the serious problems of sedentary lifestyle, obesity and smoking in the Chilean population23.
Cannoni G. et al., published a proposal for comprehensive counseling for health professionals, focused on adolescent sexuality, since it is the stage of life during which sexual identity develops and where most initiate sexual activity. Its focus is on the prevention of employment, sexually transmitted infections, and prevention of risky behaviors and strengthening of protective behaviors, all very important contents for those who perform adolescent counseling. However, it has a gender bias, as it is aimed at the adolescent and does not address the participation of the couple. It is essential to bear in mind that adolescent counseling on issues of sexuality and sexual and reproductive health is oriented, welcomes and accompanies both members of the human couple in all their diversity and sexual orientation.
Luengo M.X. et al, in an exploratory-descriptive, qualitative-quantitative study, carried out in 2009 in three Health Services of the Metropolitan Region, inquire about the knowledge that mothers and fathers have about the needs of their children in Health and Reproductive Health (SSR) and what they demand from the Services of Primary Health Care, finding that parents wanted the postponement of the sexual onset of their adolescent children, but recognized the need for prevention. The mothers approved the care in SSR and recognized the need for counseling in the aforementioned issues, requesting support for themselves and their children.